IgA肾病中医证候与尿蛋白电泳、尿视黄醇结合蛋白、尿免疫球蛋白G相关性研究

Study on the Correlation Between TCM Syndromes of IgA Nephropathy and Urinary Protein Electrophoresis and Urine-Retinolbinding Protein and Urine-Immunoglobulin G

目的:探讨IgA肾病中医证候与尿蛋白电泳、尿视黄醇结合蛋白(urine-retinolbinding protein, U-RBP)、尿免疫球蛋白G(urine-immunoglobulin G,U-IgG)的相关性。方法:选取2021年4月至2022年5月于九江市中医医院肾内科住院的IgA肾病患者120例,根据其症状表现确定证候类型,收集各证型患者一般资料、检测各证型患者血肌酐(serum creatinine, Scr)水平,于肾穿刺活检前采集患者新鲜晨尿,测定尿蛋白检出率、U-RBP及U-IgG水平,分析IgA肾病患者中医证候分型与上述各指标的关系。结果:120例IgA肾病患者中,气阴两虚证占比最高,为28.33%,其次为肝肾阴虚证、脾肾气虚证、肺肾气虚证、脾肾阳虚证,占比分别为24.17%、18.33%、15.83%和13.33%。不同证候分型IgA肾病患者病程比较,差异有统计学意义(P<0.05)。120例IgA肾病患者的尿液经SDS-AGE电泳分析后共检出93例尿蛋白阳性,其中气阴两虚证和肝肾阴虚证检出肾小球性尿蛋白的概率高于其他证型,脾肾阳虚证检出混合性尿蛋白的概率高于肺肾气虚证和脾肾气虚证(P<0.05)。不同证候分型IgA肾病患者Scr、U-RBP、U-IgG水平比较,差异具有统计学意义(P<0.05),其中脾肾气虚证或肺肾气虚证患者血清Scr、U-RBP、U-IgG水平明显低于其他3个证候分型(P<0.05)。LEE分级中,肺肾气虚证Ⅰ级占比高于肝肾阴虚证和脾肾阳虚证,Ⅳ级占比低于肝肾阴虚证;脾肾气虚证LEE分级中Ⅰ级占比高于肝肾阴虚证和脾肾阳虚证,Ⅳ级占比低于气阴两虚证和肝肾阴虚证,差异均有统计学意义(P<0.05)。结论:IgA肾病患者肾小球性、混合性尿蛋白检出率及U-RBP、U-IgG水平与中医证候有一定相关性,综合分析其相关性,可一定程度上为IgA肾病的中医辨证分型提供参考。

Objective:To study the correlation between TCM syndromes of IgA nephropathy and urinary protein electrophoresis and urine-retinolbinding protein(U-RBP)and urine-immunoglobulin G(U-IgG).Methods:A total of 120 patients with IgA nephropathy hospital-ized in the Department of Nephrology,Jiujiang Hospital of Traditional Chinese Medicine from April 2021 to May 2022 were selected.Ac-cording to their symptoms,the syndrome types were determined,the general information of patients with each syndrome type was collect-ed,and the serum creatinine(Scr)level of patients with each syndrome type was detected.Fresh morning urine was collected before re-nal biopsy,and the urinary protein detection rate,U-RBP and U-IgG levels were determined.Results:Among 120 patients with IgA ne-phropathy,qi-yin deficiency syndrome accounted for the highest proportion(28.33%),followed by liver-kidney yin deficiency syn-drome,spleen-kidney qi deficiency syndrome,lung-kidney qi deficiency syndrome,and spleen-kidney yang deficiency syndrome,ac-counting for 24.17%,18.33%,15.83%,and 13.33%,respectively.There were significant differences in the course of disease among patients with diferent syndrome types of IgA nephropathy(P<0.05).After SDS-AGE electrophoresis analysis of urine from 120 pa-tients with IgA nephropathy,93 cases were positive for proteinuria.The probability of glomerular proteinuria in qi-yin deficiency syn-drome and liver-kidney yin deficiency syndrome was higher than that in other syndrome types,and the probability of mixed proteinuria in spleen-kidney yang deficiency syndrome was higher than that in lung-kidney qi deficiency syndrome and spleen-kidney qi deficiency syndrome(P<0.05).There were significant differences in the levels of Scr,U-RBP,and U-IgG among patients with different syndrome types of IgA nephropathy(P<0.05),and the levels of serum Scr,U-RBP,and U-IgG in patients with spleen-kidney qi deficiency syn-drome or lung-kidney qi deficiency syndrome were significantly lower than those in other three syndrome types(P<0.05).In terms of the LEE classification,the proportion of lung-kidney qi deficiency syndrome at grade I was higher than that of liver-kidney yin deficiency syndrome and spleen-kidney yang deficiency syndrome,and the proportion of grade IV was lower than that of liver-kidney yin deficiency syndrome.In terms of the LEE classification of spleen-kidney qi deficiency syndrome,the proportion of grade I was higher than that of liver-kidney yin deficiency syndrome and spleen-kidney yang deficiency syndrome,and the proportion of grade IV was lower than that of qi-yin deficiency syndrome and liver-kidney yin deficiency.And all the differences were statistically significant(P<0.05).Conclu-sion:The detection rate of glomerular and mixed proteinuria,U-RBP and U-IgG levels in patients with IgA nephropathy are related to TCM syndromes.Comprehensive analysis of their correlations can provide reference for TCM syndrome differentiation of IgA nephropathy to some extent.